Charge Integrity: Proactively Correct Claim Errors

Uncover Hidden Revenue and Ensure Charge Accuracy

Hospitals and health systems lose an estimated 1% of net revenue annually due to an inability to identify claim coding errors that contribute to charge capture leakage. ZirMed’s Charge Integrity solutions automate the discovery of hidden revenue opportunities and overcharges to ensure your staff can proactively correct claim errors for accurate reimbursement and coding compliance.

ZirMed’s missing charge detection solution allows you to detect missing claim codes for both institutional and professional charges.

ZirMed’s coding variance detection solution assesses each account for CPT, HCPCS, and ICD-10 code sets to identify incorrectly coded claims and detect coding variance based on account contradictions between institutional and professional charges.

ZirMed’s Charge Integrity solution allows you to detect over-coded claims by evaluating charges at the line-item level. You can also proactively audit your claims to identify claim overcharges. Charge Integrity does this by scrutinizing quantities, determining whether claims should have been bundled, examining medical necessity policies, and identifying charges posted in error.

ZirMed’s DRG anomaly detection allows you to identify incorrectly coded claims based on a DRG anomaly.

Improve Financial Viability

Predictive analytics, data-mining, and automated rule-based audits interrogate your claims to prevent missing charges, duplicate charges, overcharges, and improperly-coded DRGs. ZirMed’s PhD credentialed data scientists fuel the algorithms and modeling intelligence behind the technology that expedites the review of hundreds of claims per minute in real-time. This helps you identify accounts with a high probability of charge issues so you can prioritize them based on the impact to net revenue.

Enhance Staff Performance

ZirMed’s RHIA-, RN- and CPC-certified auditors review and validate potential health system charge issues to ensure your staff addresses real charge issues—not false positives. ZirMed populates problematic claims into your customized workflow to keep your charge integrity team focused on impactful revenue opportunities. Each member of your team can create their own customized dashboard so they can continually manage performance.

Enhance Change Management

ZirMed’s centralized reporting process spans your entire health system, including all hospitals and owned physician practices. Doing so gives you the insight you need to address the root causes of charge issues, resolve process inefficiencies, improve coding compliance, and ensure the integrity of all inpatient and outpatient claims. ZirMed does this using a single easy-to-use cloud-based solution. You don’t need any new hardware or software, and no in-house IT support and maintenance is required.

Integration Capabilities

By design, ZirMed’s revenue cycle management platform enables creators of healthcare technology solutions to seamlessly and easily incorporate our HIPAA and PCI-compliant applications and transactions into your software solutions. Using ZirMed’s integration capabilities, organizations seeking a traditional approach of exchanging EDI transactions may transmit and receive a variety of claims, payments, eligibility inquiries, and other healthcare transactions using established technologies and methods such as X12 files, APIs, Flat Files, FTP, Encryption (i.e. PGP), and more. You’ll have confidence knowing that your exchanges are occurring securely, in compliance with all regulatory guidelines, and utilizing existing technological capabilities.

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